title: Withholding and termination of resuscitation of adult cardiopulmonary arrest secondary to trauma: resource document to the joint NAEMSP-ACSCOT position statements.
abstract: In the setting of traumatic cardiopulmonary arrest, protocols that direct emergency medical service (EMS) providers to withhold or terminate resuscitation, when clinically indicated, have the potential to decrease unnecessary use of warning lights and sirens and save valuable public health resources. Protocols to withhold resuscitation should be based on the determination that there are no obvious signs of life, the injuries are obviously incompatible with life, there is evidence of prolonged arrest, and there is a lack of organized electrocardiographic activity. Termination of resuscitation is indicated when there are no signs of life and no return of spontaneous circulation despite appropriate field EMS treatment that includes minimally interrupted cardiopulmonary resuscitation. Further research is needed to determine the appropriate duration of cardiopulmonary resuscitation before termination of resuscitation and the proper role of direct medical oversight in termination of resuscitation protocols. This article is the resource document to the position statements, jointly endorsed by the National Association of EMS Physicians and the American College of Surgeons' Committee on Trauma, on withholding and termination of resuscitation in traumatic cardiopulmonary arrest.
authors.affiliation: From the Department of Emergency Medicine (M.G.M.), and Post-Baccalaureate Pre-Med Program (A.M.), Johns Hopkins University School of Medicine; and Department of Anesthesiology and Program in Trauma (S.M.G.), R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore; Emergency Medicine Associates (S.R.K.), Germantown, Maryland; and Department of Surgery (E.M.B.), University of Washington, Seattle, Washington.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Millin
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Galvagno
authors.forename: Samiur R
authors.initials: SR
authors.lastname: Khandker
authors.forename: Alisa
authors.initials: A
authors.lastname: Malki
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
mesh_terms: D000552:Ambulances; D016887:Cardiopulmonary Resuscitation; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D016414:Resuscitation Orders; D013908:Thoracotomy; D055986:Vital Signs; D028761:Withholding Treatment / Q000191:economics / Q000592:standards; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*